Gender inequality and the use of maternal healthcare services in rural sub-Saharan Africa
Outcomes: Gender‑Based Violence, Sexual and Reproductive Health
View SourceKey Social Norms Take-aways This study highlights that social norms—specifically community-level acceptance of intimate partner violence (IPV)—negatively influence women’s use of maternal healthcare services in rural sub-Saharan Africa. The findings demonstrate that these social norms operate independently of women’s individual attitudes or decision-making power, underlining the need for policy interventions that address gender norms at the community level to improve maternal health outcomes.
Objectives The study aimed to assess how gender inequality, both at the individual level (women’s decision-making authority) and contextual level (norms accepting violence against women), influences the use of maternal healthcare services—specifically antenatal care (ANC) and skilled birth attendance (SBA)—in rural Ghana, Kenya, Tanzania, and Uganda.
Methods The authors used multilevel structural equation modeling (MSEM) on Demographic and Health Survey (DHS) data collected between 2003 and 2006. The analysis focused on women aged 15–49 who had a live birth in the five years preceding the survey. Gender norms were modeled as latent variables derived from responses to five questions about the justification of IPV under various circumstances.
Intervention Details Not applicable. This was a research study, not an intervention.
Results The study found that in Ghana, Uganda, and Tanzania, women residing in communities with permissive norms toward IPV were significantly less likely to access skilled birth attendance or timely antenatal care. For example, Ghanaian women in such communities were less likely to begin ANC in the first trimester and to use skilled attendants at birth. In Tanzania, similar norms were associated with fewer ANC visits. In contrast, the impact of individual-level decision-making authority was generally weaker and less consistent across countries.
Conclusions Gender norms that tolerate violence against women substantially hinder the uptake of maternal health services, even more so than individual women’s autonomy. The findings suggest that improving maternal healthcare utilization in rural sub-Saharan Africa requires addressing gender norms at the community level, not just empowering women individually.
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